Surviving breast cancer depends in great part on early detection. Manual Clinical breast examination (CBE) and breast self-examination (BSE) are important components of screening asymptomatic women. To detect reliably the smallest palpable lesions, manual examination must be proficient and thorough. The results of research studies on the MammaCare(R) system of breast examination suggest that it significantly improves CBE and BSE skills. The Mammacare Personal Learning System instructs women audiovisually to examine a lifelike breast model that contains synthetic nodularity and lesions. The system trains women to cover completely all breast tissue using three palpation pressures and to identify accurately important internal tissue structures, first on the tactile model and then on their own breast tissue. This potentially life-saving technology must be adapted for women with disabilities. According to the U.S. Bureau of the Census, about 10 million women have vision or hearing impairments. These women are at the same risk as their unimpaired counterparts, but they Cannot learn to do competent BSE using existing audiovisual training procedures. This SBIR proposal supports the development and validation of adaptive instructional materials to allow women with vision and hearing impairments to use Mammacare. PROPOSED COMMERCIAL APPLICATION: The proposed adaptive products for breast self-examination (BSE) have a large potential audience. There are approximately 10 million women in the United States with vision or hearing impairments who will be able to use the applicant's system as a result of this SBIR program.